Item 9.2 Grampian Area Clinical Forum 26 11 08

NHS GRAMPIAN

Minute of the Area Clinical Forum Meeting

held on Wednesday 26 November 2008 at 6.00pm

In the Conference Room, Summerfield House

Present

Dr John Reid, Chair, Area Medical Committee (Chair)

Mrs Fiona Arris, Vice Chair, Area Pharmaceutical Committee

Dr David Fowler, Chair, GP Sub-Committee

Mrs Linda Juroszek, Chair, Area Pharmaceutical Committee

Mr Graeme Shand, Chair, Area Optometric Committee

Mrs Elizabeth Squires, Vice Chair, Grampian Area Nursing & Midwifery Advisory Committee

Ms Jennie Tait, Chair, Area Healthcare Science Forum

By Invitation

Dr Roelf Dijkhuizen, Medical Director

Mrs Elinor Smith, Director of Nursing

In Attendance

Mrs Lorraine Scott, Service Planning Lead for Public Health and Planning – Item 2 only

Mrs Rosie Gauld, Clerk to the Professional Advisory Committees

Item / Subject / Action
1. /

Chair’s Welcome

Dr Reid introduced Mrs Lorraine Scott who was to give a presentation on the Grampian Health Plan.
2 /

Grampian Health Plan

Mrs Scott gave a powerpoint presentation, a copy of which would be e-mailed to all members.
Following discussion, Mrs Squires stated that the following themes had emerged from the presentation to GANMAC:-
- shifting the balance of care, demographics, rural transport, recruitment and affordability, communicating honestly with staff, user friendly documents, waiting times and future needs, clear planning in educational needs and career structure
- accessibility for patients and public, interlinking of IT systems to enable co-ordination of tests and results, investment in IT, clear and concise approach with public, educating public re role of nurse.
- promote good parts of service to public and show recognition of work done, promote and evidence joint working, more information on children/maternity services and health campus/nursing at RGU, promote development opportunities within staff roles, investment in IT
Ms Tait highlighted workforce issues, modernisation of scientific careers and a major issue of accommodation.
APC
– Developing the workforce to meet the remit of the new pharmacy contract; accessibility; skill mix. No clarity around how pharmacists are seen as contractors and managing “tensions” that may develop. Need to be more open and have involvement at meetings.
Dr Reid then summed up that the issues and the recurring themes were:-
Question 1
 Workforce
 Demographics
 Shifting the balance of Care
 Infrastructure
Question 2
 Access to services including physical access
 Communication including IT
 Appropriate service provision
Question 3
It was agreed to await the draft which Mrs Scott would produce, following which she would attend the ACF in December. / LS
Dr Dijkhuizen stated that the Better Care Project Team had identified as a challenge to combine the strategic objectives of Shifting the Balance of Care with that of accessibility. Regarding infrastructure, the capital plan was being adjusted.
Mrs Juroszek stated that eHealth video/tele-conferencing should be a priority
3 / Apologies
Steven Lindsay, Fiona McKenzie and Malcolm McPherson.
Dr Reid intimated that Helen Murray was now in post as Clerk to the Professional Advisory Committees but was on sick leave, therefore Rosie Gauld was taking the Minute in her place.
4 / Notes of Meeting held on 29 October 2008
The Notes were approved as a correct record.
5 / Matters Arising
Nil.
6 / Living and Dying Well
7 / Audit Commission Report on Palliative Care
These two reports were discussed in tandem as the Living and Dying Well Action Plan had been developed from the Audit Scotland Report.
Dr Reid intimated that one of the issues GPs had was the dearth of carers to support colleagues and families of those requiring palliative care at home. Dr Dijkhuizen stated that many services were delivered by carers, voluntary organisations and charities and the proposal within the Government document was that there would be a move to palliative care to any patient who had come to the end of their life. Therefore, consideration had to be given to how charities, voluntary organisations and NHS could work together. It was noted that 90% of terminally ill patients were nursed at home but 20% died as a result of cancer. The Living and Dying Well document had been well received by service providers and they were keen to respond. It was noted that a response was required by the end of March 2009.
Dr Dijkhuizen was in the process of setting up a Palliative Care Focus Group of cancer specialists. This group would form the Action Plan for NHS Grampian and Dr Dijkhuizen hoped to return to the ACF with a local response.
With regard to anticipatory care, Mrs Elinor Smith had met with Angus Cooper, Clinical Lead who, along with his colleagues, were looking at the “Do Not Resuscitate” policy and inappropriate end of life admissions to hospital. In terms of children and young people, a Nurse Consultant had been appointed (Francis Edwards) to develop palliative care plans for children and young people, not just with cancer but with any terminal conditions.
Mrs Squires intimated that it was difficult to have contact with specialists to support the family of a dying child at home. There were also inappropriate referrals from Care Homes and Linda Harper had raised the out-of-hours perspective where the patient’s wishes were not well-documented. There were also issues with those patients who did not have the capacity to say what they wanted, therefore a written plan was required.
Dr Fowler stated that the D hospital-based policy produced by Dr W Primrose had been discussed at the GP Sub-Committee. Once finalised everyone who required it, would have access to the
Dr Dijkhuizen advised that thought had to be given to what could be done for the patient to make a difference to their quality of life and experience. NHS Grampian had a good tradition of palliative care knowledge and expertise in the community although there had been criticism for not having Palliative Care Centres to deal with anticipatory care.
Dr Reid queried whether the Focus Group would deal with partnership issues as there were different situations, eg elderly person living alone; elderly people with one carer; elderly with family.
It was confirmed that dispensing medication would be addressed. Mrs Juroszek stated that the Pharmacy Group would be looking at issues around responsibility for some aspects of palliative care, including medication. Pharmacists would be included in the Focus Group.
Mrs Smith advised that this linked in with the Patient Safety Programme. Various wards in ARI had been looking at the information given to staff at handover meetings, focussing on patient safety, patients with infection and DNARs although there were not many patients in the latter category. This was seen as an example of good practice.
There were no pre-conceived ideas that there should be an MCN or something similar. In terms of service provision, eg Motor Neurone Disease, there was a need to discuss with clinicians that consultation with other clinicians may be required to provide the best standard of care for terminally ill patients.
Finally Dr Dijkhuizen confirmed that membership of the Focus Group would include representation of the community; unscheduled care; pharmacy and two representatives of each CHP (NHS Grampian and Local Authority).
Dr Dijkhuizen would report back at a future ACF meeting. / RD
8 / Decontamination of Equipment Policy
Submitted document entitled “Policy – Decontamination of Equipment (Cleaning, Disinfection, Sterilisation), copies of which had been circulated prior to the meeting.
Dr Reid stated that clarity was required whether the policy related to contractors and staff or solely NHS Grampian. The policy raised several issues for GPs and out-sourcing equipment for minor operations and sourcing equipment through the central supply route.
Mrs Smith advised that the Director of Facilities and his team had been instructed to produce a policy under the HAI requirements. ACF members were asked to feed back any comments on the policy to Eric Murray. / All
Ms Tait advised that there was a Health & Safety policy for dealing with spillages.
Mr Shand stated that if the policy was for contractors, then Optometry and Ophthalmology should be included.
9 / Current Issues from the Advisory Committees
9.1 AHPAC – Nil
9.2 AOC
 CHP Clinical Optometric Leads for each CHP (Shire and City – one session per week; Moray – half session per week) will be advertised within the next few weeks to work within an MCN being proposed
 4 PGDs starting training, in Aberdeen and Elgin, in the New Year for the Eye Health Network.
9.3 APC
 The EHC national PGD is up and running. Three pharmacies in Grampian not providing that service.
 Chlamydia testing not yet finalised – issues around the test kits and how NHSG will deal with the results to the individuals. Prescriptions will be a PGD from the pharmacist. Contact tracing not yet decided.
9.4 GANMAC
 Feedback given on the NHSG Safeguarding Patient Records Outwith Health Records Libraries and in Transit
 Charge Nurse Review ongoing. Pilot sites up and running
 Hand hygiene audits
 Study on antimicrobial antibiotic prescribing
 Sickness/absences still a challenge. Not meeting 4% target. Worth pursuing with OHS
 Suicide prevention – going well
 KSF ongoing
 Reducing Health and Inequalities – discussion around out of hours service
 Care Home issues – recruited staff from Southern Cross Care Home to NHSG and concerns that the local homes may have to close. Need to build bridges with the Care Homes. Seeking a representative to sit on GANMAC
 Continuing to run Recruitment Fairs in the Shire, particularly for untrained staff
 Delayed discharge policy
 Difficulties in accessing IT
 Nurse development posts in Primary Care – need to look at skill mix and different roles. Emphasis has been on the Charge Nurse Review.
9.5 Healthcare Science Forum
 To attend a meeting on Friday 28 November 2008 re modernising scientific careers. Review throughout the UK. 51 different disciplines under the scientific banner. Lots of different routes for education and training
 Difficulties recruiting staff in Scotland. Staff who are BMS are regulated by HPC but many disciplines not regulated. Meeting will be looking at trying to change practices and recruitment and retention.
 IT – issues when there are generator tests over the weekend and lab results cannot be dealt with. iSoft does not support the system for Labs over weekends. Impacts on patient safety.
9.6 AMC
 Difficulties in communication between primary and secondary care. Wrote to GM – Acute Sector and awaiting a response
 Difficulties with medical notes in hospital being culled after six years. GPs are often being asked to let the hospital have copies of letters for patients who may have an ongoing condition, eg MS. Dr Dijkhuizen stated that a Medical Records Storage policy had been developed after discovering that there was no accommodation for the storage of records, and there was a national policy which allowed the destruction of records after a period of six years. However, there were exceptions when certain records could not be destroyed.
Dr Dijkhuizen stated that he had had extensive discussions and would be interested to hear of the issues concerning GPs, how often they were being asked to provide copy records etc which could form a review of the policy. Contact Stuart Scott, Director of Health Informatics.
Jennie Tait intimated that Lab reports etc had to be kept for the lifetime of the patient.
9.6.1 GP Sub-Committee
 Primary Care Nursing Teams are being moved away from being Practice-based to a Locality base. It was felt that this was moving away from Teams that work effectively and that good team working was being lost. To this end CHPs had been asked to attend the next GP Sub-Committee. Elinor Smith advised that a pilot had been undertaken in Torry and was looking to roll it out to other places.
9.6.2 Consultants’ Sub-Committee
Nil.
9.7 OMT
 Patients’ Rights Bill – comments required by Christmas to Laura Gray who will respond on behalf of NHSG
 Child Protection Strategy – comments required.
A copy of the OMT agenda and Minutes will be e-mailed to ACF for information. / HM
10 / Chair’s Report
10.1Dr Reid reported that he had attended a meeting of the Asset Investment Group on Monday 24 November 2008. The credit crunch was having a significant impact upon NHSG assets. There were also issues around the Scottish Government “rule” that redeveloped facilities will have 50% single room occupancy and new builds will be 100%.
10.2 Advisory Structure Objectives
Dr Reid had received a paper prepared by Alan Gray of PricewaterhouseCoopers, copies of which would be sent to all members. The paper set out levels of reimbursement, meetings times and budgets. On receipt of the paper, Dr Reid asked for members comments regarding:-
(a) what was required regarding budgets
(b) level of reimbursement
(c) governance of payments
To be discussed at the next meeting.
In the meantime it was noted that members of the GP Sub-Committee do not get paid locum fees but are paid an annual sum.
There was also a query about people travelling a distance to a meeting – do they get paid just for the duration of the meeting or the time they left their place of work. Mr Shand confirmed that Optometrists are paid for the time out of Practice. / JR
All
11 / ACF Letter to the Board
The ACF letter to the Board dated 24 November 2008 was noted, copies of which had been circulated previously with the agenda.
12 / REPORTS
12.1 eHealth Committee, 15 August 2008
Issues regarding tele-conferencing and IT, eg nhs.net were highlighted.
12.2 Child Protection
 Mrs Smith reported that the three Local Authorities had been inspected and written reports had been received for the Shire and Aberdeen City. A draft report was expected shortly for Moray. Date for publication is February 2009. Issues were raised within the reports that would be taken forward.
 NESCPC was developing a plan for multi-agency working
 An integrated health plan was being drawn up within the NHS Quality Group
 The Child Protection Strategy was being revised and comments were welcomed.
12.3Others – Nil
13 / MINUTES
Receipt of the following Minutes was noted:-
OMT – 24 September 2008
APC – 7 October 2008
AHP – 8 May 2008
GANMAC – 9 September 2008
GP Sub-Committee – 27 October 2008
Consultants’ Sub-Committee – 9 October 2008
14 / ITEMS FOR NOTING
Nil.
15 / OTHER COMPETENT BUSINESS
No further items were raised.
16 / DATE OF NEXT MEETING
Wednesday 17 December 2008 at 6.00 pm in the Conference Room.